Basic Information
| Provider Information | |||||||||
| NPI: | 1194786608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | QUIST-THERSON | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 21182 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103688640 | ||||||||
| FaxNumber: | 4103688644 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 CATON AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103682783 | ||||||||
| FaxNumber: | 4103683599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2006 | ||||||||
| LastUpdateDate: | 09/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | D0060105 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | D0060105 | MD | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 62092201 | 01 | MD | CAREFIRST | OTHER | W662 | 01 | DC | CAREFIRST | OTHER | K519 | 01 | MD | CAREFIRST | OTHER | 0083 | 01 | DC | CAREFIRST | OTHER |